Elderly, care spending soars to 21 billion: uphill challenge for supplementary funds

The time bomb of non-self-sufficiency for the accounts of our Welfare has already exploded for some time: there are at least 4 million frail elderly people who need continuous care and assistance, and if in 2050, as the forecasts say, one Italian in three will be over 65 (today they are one in four) it is easy to understand how the accounts will be definitively unsustainable. Today public spending on so-called long-term care for the elderly and the disabled is worth about 35 billion a year, of which 13 billion is strictly health care spending, 15 billion for accompaniment allowances, and about 7 billion for services provided at the local level. A mountain of money that is absolutely not enough, given that Italians out of their own pockets - the so-called 'out of pocket' expenditure - spend the maxi figure of EUR 21 billion to guarantee care and assistance for themselves and their loved ones, which becomes over EUR 30 billion if we include the direct and indirect costs for carers and caregivers who provide services without regular contracts. Numbers in the face of which even the recent reform on non-self-sufficiency can do very little, as in the case of the elderly bonus of 850 euros per month that, given the stringent limits - starting with the Isee under 6,000 euros - has reached only a few thousand over 80 (against a potential audience of only 25,000 elderly).

This is why, alongside an increasingly struggling NHS, the path of supplementary healthcare, the second pillar, is absolutely inescapable for the current and future millions of dependent people: long-term care (Ltc) is the subject of a survey contained in the latest supplementary health magazine by LavoroWelfare, in which six of the largest supplementary funds operating in Italia today were interviewed in addition to various experts in the sector, with around 6.5 million members out of a total of 16.3 million Italians who are members of the 324 funds present in Italy. Under the lens of this survey Fondo Est (commerce, tourism), Empapi (professionals), Sanedil (construction) SanArti (artisans), Fasi (managers), MetaSalute (metalworkers, goldsmiths and silversmiths). The survey shows how the health expenditure of the Funds sees dentistry prevailing - 'confirming the historically central role of this area' not covered by the SSN - specialist examinations, high diagnostics and surgery, with emerging areas such as mental health. The funds in the LavoroWelfare survey recognise the need to "review or update some services, especially in relation to changes in health needs and new emerging frailties", the survey warns. Some funds already provide dedicated benefits, while others have not yet developed structured coverage". In the sample analysed, for example, 4 out of 6 funds provide Ltc benefits with different solutions: "assistance services, annuities or mixed models", where in any case an indemnity logic still prevails instead of a real "taking charge" of often very complex needs that, in order to be economically sustainable, must increasingly focus on a "collective capitalisation" of the non-self-sufficiency risk. "The progressive ageing of the Italian population, together with the significant decrease in the birth rate and the progressive increase in the dependency ratio of the elderly with respect to the cohorts of individuals of working age, determines particularly critical conditions for achieving an optimal solution to the problem," warn Cesare Damiano President Lavoro&Welfare and Paolo De Angelis Co-President Studio De Angelis Savelli e Associati. They emphasise how crucial it is by now that "the coverage of a systemic risk such as non-self-sufficiency necessarily requires a solution based on a full principle of mutuality between generations, realised through legislative solutions that permit a full synergy between the public and private sectors in which, in particular health funds and pension funds, can play a decisive role in contributing to the protection of workers and pensioners from this risk by also providing for special contributions paid by workers and companies".